Accuracy of patient-reported spell duration: A comparative study.

Clinicians rely heavily on patient histories to make medical diagnoses, most of which are inherently subjective and prone to inaccuracies. The aim of this study is to compare the subjective versus objective duration of spells through a retrospective chart review of patients admitted to the epilepsy monitoring unit at our tertiary care medical center. One hundred patients were analyzed. Differences in the accuracy of subjective estimations versus objective duration were compared by age, sex, focal versus generalized, location (frontal versus non-frontal), and spell type (focal aware versus impaired awareness and epileptic versus non-epileptic). Our data show that patients are poor subjective estimators, with 73% of patients overestimating the duration of their spells. We did not find differences in estimated duration by age, sex, seizure location or spell type. A notable exception was patients with generalized convulsive seizures, who accurately reported spell duration to within 17 s. This is likely because these seizures are stereotypical, and patients/family time them. Moreover, patients with non-epileptic spells were worse estimators of their spell duration than those with epileptic spells. In addition, although the prefrontal lobe plays a role in time estimation, we did not find that patients with frontal lobe seizures were worse estimators than those with non-frontal seizures, but invasive monitoring can more precisely localize seizures within areas of the frontal lobe responsible for time estimation. Our data emphasize the importance of not relying solely on patient-reported time estimation in diagnosing and developing treatment plans and instead instructing patients to time their spells.

Patient Safety in Canadian Epilepsy Monitoring Units: A Survey of Current Practices.

BACKGROUND: Guidelines on epilepsy monitoring unit (EMU) standards have been recently published. We aimed to survey Canadian EMUs to describe the landscape of safety practices and compare these to the recommendations from the new guidelines. METHODS: A 34-item survey was created by compiling questions on EMU structure, patient monitoring, equipment, personnel, standardized protocol use, and use of injury prevention tools. The questionnaire was distributed online to 24 Canadian hospital centers performing video-EEG monitoring (VEM) in EMUs. Responses were tabulated and descriptively summarized. RESULTS: In total, 26 EMUs responded (100% response rate), 50% of which were adult EMUs. EMUs were on average active for 23.4 years and had on average 3.6 beds. About 81% of respondents reported having a dedicated area for VEM, and 65% reported having designated EMU beds. Although a video monitoring station was available in 96% of EMUs, only 48% of EMUs provided continuous observation of patients (video and/or physical). A total of 65% of EMUs employed continuous heart monitoring. The technologist-to-patient ratio was 1:1-2 in 52% of EMUs during the day. No technologist supervision was most often reported in the evening and at night. Nurse-to-EMU-patient ratio was mostly 1:1-4 independent of the time of day. Consent forms were required before admission in 27% of EMUs. CONCLUSION: Canadian EMUs performed decently in terms of there being dedicated space for VEM, continuous heart monitoring, and adequate nurse-to-patient ratios. Other practices were quite variable, and adjustments should be made on a case-by-case basis to adhere to the latest guidelines.

Research on a Fault Feature Extraction Method for an Electric Multiple Unit Axle-Box Bearing Based on a Resonance-Based Sparse Signal Decomposition and Variational Mode Decomposition Method Based on the Sparrow Search Algorithm.

In light of the issue that the vibration signal from an axle-box bearing collected during the operation of an electric multiple unit (EMU) is seriously polluted by background noise, which leads to difficulty in identifying fault characteristic frequency, this paper proposes a resonance-based sparse signal decomposition (RSSD) and variational mode decomposition (VMD) method based on sparrow search algorithm (SSA) optimization to extract the fault characteristic frequency of the bearing. Firstly, the RSSD method is utilized to decompose the signal based on the obtained optimal combination of quality factors, resulting in the optimal low-resonance component with periodic fault information. Then, the VMD method is performed on this low-resonance component. The parameter combinations for both methods are optimized utilizing the SSA method. Subsequently, envelope demodulation is applied to the intrinsic mode function (IMF) with maximum kurtosis, and fault diagnosis is achieved by comparing it with the theoretical fault characteristic frequency. Finally, experimental validation and comparison are conducted by utilizing simulated signals and example signals. The results demonstrate that the proposed method extracts more obvious periodic fault impact components. It effectively filters out the interference of complex noise and reduces the blindness of setting weights on parameters due to human experience, indicating excellent adaptability and robustness.

EU Economic Governance as a Supranational Determinant of Health Inequalities in the Eurozone.

The COVID-19 pandemic raises the question of austerity's problematic social toll for health in the south of Europe. Has EU economic governance constrained health spending? If so, have these spending levels led to inequalities, which in turn shaped responses to the pandemic? EU economic governance is often dismissed as ineffective because of its poor track record of compliance. Yet austerity is blamed for negative health outcomes. This article shows that the EU fiscal rule is a determinant of health because it affects fiscal policies of European countries. First, the analysis of EU member states during 1995-2018 shows that austerity policies affect health spending and health inequalities. Euro-area countries under the EU Excessive Deficit Procedure significantly consolidated their health spending. The contractionary effect was concentrated in southern countries, contributing to rising health inequalities across the core and periphery. Finally, the analysis shows the pandemic implications of health inequalities, as periphery countries with a track record of high consolidation display more stringent (and costly) COVID-19 response models. This analysis contributes to understanding the supranational determinants of health in the EU, showing the pervasive spillover effects of the fiscal framework on national health policies.

Epilepsy center characteristics and geographic region influence presurgical testing in the United States.

OBJECTIVE: Persons with drug-resistant epilepsy may benefit from epilepsy surgery and should undergo presurgical testing to determine potential candidacy and appropriate intervention. Institutional expertise can influence use and availability of evaluations and epilepsy surgery candidacy. This census survey study aims to examine the influence of geographic region and other center characteristics on presurgical testing for medically intractable epilepsy. METHODS: We analyzed annual report and supplemental survey data reported in 2020 from 206 adult epilepsy center directors and 136 pediatric epilepsy center directors in the United States. Test utilization data were compiled with annual center volumes, available resources, and US Census regional data. We used Wilcoxon rank-sum, Kruskal-Wallis, and chi-squared tests for univariate analysis of procedure utilization. Multivariable modeling was also performed to assign odds ratios (ORs) of significant variables. RESULTS: The response rate was 100% with individual element missingness < 11% across 342 observations undergoing univariate analysis. A total of 278 complete observations were included in the multivariable models, and significant regional differences were present. For instance, compared to centers in the South, those in the Midwest used neuropsychological testing (OR = 2.87, 95% confidence interval [CI] = 1.2-6.86; p = .018) and fluorodeoxyglucose-positron emission tomography (OR = 2.74, 95% CI = = 1.14-6.61; p = .025) more commonly. For centers in the Northeast (OR = .46, 95% CI = .23-.93; p = .031) and West (OR = .41, 95% CI = .19-.87; p = .022), odds of performing single-photon emission computerized tomography were lower by nearly 50% compared to those in the South. Center accreditation level, demographics, volume, and resources were also associated with varying individual testing rates. SIGNIFICANCE: Presurgical testing for drug-resistant epilepsy is influenced by US geographic region and other center characteristics. These findings have potential implications for comparing outcomes between US epilepsy centers and may inject disparities in access to surgical treatment.

Creation of an advancing adult and pediatric neurology resident EEG curriculum.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) milestones state that neurology residents should be able to "interpret common EEG abnormalities, recognize normal EEG variants, and create a report." Yet, recent studies have shown that only 43% of neurology residents express confidence in interpreting EEG without supervision and can recognize less than half of normal and abnormal EEG patterns. Our objective was to create a curriculum to improve both confidence and competence in reading EEGs. METHODS: At Vanderbilt University Medical Center (VUMC), adult and pediatric neurology residents have required EEG rotations in their first and second years of neurology residency and can choose an EEG elective in their third year. A curriculum consisting of specific learning objectives, self-directed modules, EEG lectures, epilepsy-related conferences, supplemental educational material, and tests was created for each of the three years of training. RESULTS: Since the implementation of an EEG curriculum at VUMC from September 2019 until November 2022, 12 adult and 21 pediatric neurology residents completed pre- and post-rotation tests. Among the 33 residents, there was a statistically significant improvement in post-rotation test scores, with a mean score improvement of 17% (60.0 ± 12.9 to 77.9 ± 11.8, n = 33, p < 0.0001). When differentiated by training, the mean improvement of 18.8% in the adult cohort was slightly higher than in the pediatric cohort, 17.3%, though it was not significantly different. Overall improvement was significantly increased in the junior resident cohort with a 22.6% improvement in contrast to 11.5% in the senior resident cohort (p = 0.0097 by Student's t-test, n = 14 junior residents and 15 senior residents). DISCUSSION: With the creation of an EEG curriculum specific to each year of neurology residency, adult and pediatric neurology residents demonstrated a statistically significant mean improvement between pre- and post-rotation test scores. The improvement was significantly higher in junior residents in contrast to senior residents. Our structured and comprehensive EEG curriculum objectively improved EEG knowledge in all neurology residents at our institution. The findings may suggest a model which other neurology training programs may consider for the implementation of a similar curriculum to both standardize and address gaps in resident EEG education.

Retrospective analysis of nurse-administered fall assessment scales in the Epilepsy Monitoring Unit.

INTRODUCTION: Inpatient falls within the Epilepsy Monitoring Unit (EMU) are a common, and potentially preventable adverse event contributing to morbidity for patients living with epilepsy. Accurate fall risk screening is important to identify and efficiently allocate proper safety measures to high-risk patients, especially in EMUs with limited resources. We sought to compare existing screening tools for the ability to predict falls in the EMU. METHODS: This is a retrospective, single-center, case-controlled, comparative analysis of 7 nurse-administered fall risk assessment tools (NAFRAT) of patients admitted to the Vanderbilt University Medical Center (VUMC) EMU. Analysis of categorical data was compared using chi-square analysis while quantitative distributions were compared using student's t-test. RESULTS: A total of 56 patient records (28 falls and 28 controls) were included in the analysis. Epilepsy Monitoring Unit falls were most common within the first 3 days of admission (p = .0094). Pre-admission documentation of falls was a strong predictor of falls within the EMU (p < .0001). Epilepsy Monitoring Unit falls were associated with documented falls after EMU discharge (p = .011). The John Hopkins fall risk assessment tool (JHFRAT) accurately stratified fall risk in the fall group compared to the control (p = .008), however, none of the 7 NAFRATs demonstrated significant categorical differences among the epilepsy subgroups. There was a significant difference in the distribution of quantitative scores, higher in the fall group according to the Morse Fall Scale (MFS) (p = 0.012), JHFRAT (p = 0.003), Schmid Fall Risk Assessment Scale (p = 0.029) and Hester-Davis Scale (p = 0.049). The modified Conley (p = 0.03) and Morse scale (p = 0.025) demonstrated differences in the distribution of quantitative scores in the epilepsy subgroups. CONCLUSION: The findings of this study demonstrate variable accuracy of NAFRATs in assessing fall risk among patients admitted to the EMU, particularly among patients with epilepsy. The findings underscore the need for a validated, EMU-specific, fall assessment tool that accurately stratifies fall risk and inform efficient use of patient-specific fall prevention resources and protocols.

Emu Oil and zinc monoglycerolate independently reduce disease severity in a rat model of ulcerative colitis.

Ulcerative colitis is characterized by colonic inflammation. Previously, Emu Oil protected the intestine against experimentally-induced inflammatory intestinal disorders. Zinc monoglycerolate (ZMG) polymer, formed by heating zinc oxide with glycerol, demonstrated anti-inflammatory and wound healing properties. We aimed to determine whether ZMG, alone or in combination with Emu Oil, could reduce acute colitis severity in rats. Male Sprague Dawley rats (n = 8/group) were orally-administered either vehicle, ZMG, Emu Oil (EO) or ZMG combined with EO (ZMG/EO) daily. Rats were provided ad libitum access to drinking water (Groups 1-4) or dextran sulphate sodium (DSS; 2%w/v; Groups 5-8) throughout the trial (days 0-5) before euthanasia on day 6. Disease activity index, crypt depth, degranulated mast cells (DMCs) and myeloperoxidase (MPO) activity were assessed. p < 0.05 was considered significant. DSS increased disease severity (days 3-6) compared to normal controls (p < 0.05). Importantly, in DSS-administered rats, ZMG/EO (day 3) and ZMG (day 6) reduced disease activity index compared to controls (p < 0.05). Following DSS consumption, distal colonic crypts lengthened (p < 0.01), occurring to a greater extent with EO compared to ZMG and ZMG/EO (p < 0.001). DSS increased colonic DMC numbers compared to normal controls (p < 0.001); an effect decreased only by EO (p < 0.05). Colonic MPO activity increased following DSS consumption (p < 0.05); notably, ZMG, EO and ZMG/EO treatments decreased MPO activity compared to DSS controls (p < 0.001). EO, ZMG and ZMG/EO did not impact any parameter in normal animals. Emu Oil and ZMG independently decreased selected indicators of colitic disease severity in rats; however, the combination did not reveal any additional benefit.

Identifying inpatient hospitalizations with continuous electroencephalogram monitoring from administrative data.

BACKGROUND: Continuous electroencephalography (cEEG) is increasingly utilized in hospitalized patients to detect and treat seizures. Epidemiologic and observational studies using administrative datasets can provide insights into the comparative and cost effectiveness of cEEG utilization. Defining patient cohorts that underwent acute inpatient cEEG from administrative datasets is limited by the lack of validated codes differentiating elective epilepsy monitoring unit (EMU) admissions from acute inpatient hospitalization with cEEG utilization. Our aim was to develop hospital administrative data-based models to identify acute inpatient admissions with cEEG monitoring and distinguish them from EMU admissions. METHODS: This was a single center retrospective cohort study of adult (≥ 18 years old) inpatient admissions with a cEEG procedure (EMU or acute inpatient) between January 2016-April 2022. The gold standard for acute inpatient cEEG vs. EMU was obtained from the local EEG recording platform. An extreme gradient boosting model was trained to classify admissions as acute inpatient cEEG vs. EMU using administrative data including demographics, diagnostic and procedure codes, and medications. RESULTS: There were 9,523 patients in our cohort with 10,783 hospital admissions (8.5% EMU, 91.5% acute inpatient cEEG); with average age of 59 (SD 18.2) years; 46.2% were female. The model achieved an area under the receiver operating curve of 0.92 (95% CI [0.91-0.94]) and area under the precision-recall curve of 0.99 [0.98-0.99] for classification of acute inpatient cEEG. CONCLUSIONS: Our model has the potential to identify cEEG monitoring admissions in larger cohorts and can serve as a tool to enable large-scale, administrative data-based studies of EEG utilization.

Numerical Simulation and Analysis of Turbulent Characteristics near Wake Area of Vacuum Tube EMU.

Due to aerodynamic resistance, aerodynamic noise, and other problems, the further development of traditional high-speed electric multiple units (EMUs) on the open line has been seriously restricted, and the construction of a vacuum pipeline high-speed train system has become a new solution. In this paper, the Improved Detached Eddy Simulation (IDDES) is used to analyze the turbulent characteristics of the near wake region of EMU in vacuum pipes, so as to establish the important relationship between the turbulent boundary layer, wake, and aerodynamic drag energy consumption. The results show that there is a strong vortex in the wake near the tail, which is concentrated at the lower end of the nose near the ground and falls off from the tail. In the process of downstream propagation, it shows symmetrical distribution and develops laterally on both sides. The vortex structure far from the tail car is increasing gradually, but the strength of the vortex is decreasing gradually from the speed characterization. This study can provide guidance for the aerodynamic shape optimization design of the rear of the vacuum EMU train in the future and provide certain reference significance for improving the comfort of passengers and saving the energy consumption caused by the speed increase and length of the train.

A new method for molecular sex identification in the emu (Dromaius novaehollandiae).

1. Sex chromosomes of emus are largely homomorphic. Therefore, the standard methodology for molecular sexing based on screening intron length variations in sex-linked genes is not applicable. However, emu sexing requires costly and time-consuming PCR-RFLP or multiplex PCR methods.2. This experiment used a directed PCR amplification and capillary electrophoresis sexing protocol. Two distinct peaks were observed in females (ZW), while only one peak was observed in males (ZZ).3. This sexing technique proved to be rapid, non-invasive, and highly sensitive and may be useful for verifying the sex ratio and breeding management of emus.

A new candling procedure for thick and opaque eggs and its application to avian conservation management.

The ability to monitor developing avian embryos and their associated vascular system via candling enables the application of important reproductive management techniques. Egg candling facilitates the confirmation of egg viability throughout the incubation process and identification of a precise position on a vein for the safe extraction of blood. Blood samples may then be analysed to retrieve vital health and genetic information to assist in conservation management. However, the thick or opaque egg shell characteristics of some avian species prevents the observation of egg contents using traditional candling methods, thus limiting management options. This paper tests a novel method of preparing thick-shelled or opaque eggs so that traditional egg candling and blood extraction methods may be applied. Eggs from captive emu (Dromaius novaehollandiae, Latham 1790) and southern cassowary (Casuarius casuarius johnsonii, Linnaeus 1758) were obtained, and partial fenestration was performed on two areas of shell either before incubation or at ⅓ of incubation. Hatchability and weight loss were examined as a measure of effect of the fenestration process on the developing embryo. Clear observation of vascular development was successful in 97% of viable fenestrated eggs, without affecting hatchability or weight loss. Blood samples were taken from developing embryos and DNA was successfully extracted for proof of concept of this new technique. The ability to observe vascular development and monitor the developing embryo in thick and opaque eggs will significantly improve both in situ and ex situ population management options such as in ovo sexing in species of concern.

Osteohistological description of ostrich and emu long bones, with comments on markers of growth.

Ostriches and emus are among the largest extant birds and are frequently used as modern analogs for the growth dynamics of non-avian theropod dinosaurs. These ratites quickly reach adult size in under 1 year, and as such do not typically exhibit annually deposited growth marks. Growth marks, commonly classified as annuli or lines of arrested growth (LAGs), represent reduced or halted osteogenesis, respectively, and their presence demonstrates varying degrees of developmental plasticity. Growth marks have not yet been reported from ostriches and emus, prompting authors to suggest that they have lost the plasticity required to deposit them. Here we observe the hind limb bone histology of three captive juvenile emus and one captive adult ostrich. Two of the three juvenile emus exhibit typical bone histology but the third emu, a 4.5-month-old juvenile, exhibits a regional arc of avascular tissue, which we interpret as a growth mark. As this mark is not present in the other two emus from the same cohort and it co-occurs with a contralateral broken fibula, we suggest variable biomechanical load as a potential cause. The ostrich exhibits a complete ring of avascular, hypermineralized bone with sparse, flattened osteocyte lacunae. We identify this as an annulus and interpret it as slowing of growth. In the absence of other growth marks and lacking the animal's life history, the timing and cause of this ostrich's reduced growth are unclear. Even so, these findings demonstrate that both taxa retain the ancestral developmental plasticity required to temporarily slow growth. We also discuss the potential challenges of identifying growth marks using incomplete population data sets and partial cortical sampling.

Predictive value of video alone in diagnosis of epileptic vs paroxysmal nonepileptic events in children.

OBJECTIVE: Previous studies examined the use of video-based diagnosis and the predictive value of videos for differentiation of epileptic seizures (ES) from paroxysmal nonepileptic events (PNEE) in the adult population. However, there are no such published studies strictly on the pediatric population. Using video-EEG diagnosis as a gold standard, we aimed to determine the diagnostic predictive value of videos of habitual events with or without additional clinical data in differentiating the PNEE from ES in children. METHODS: Consecutive admissions to our epilepsy monitoring unit between June 2020 and December 2020 were analyzed for events of interest. Four child neurologists blinded to the patient's diagnosis formulated a diagnostic impression based upon the review of the video alone and again after having access to basic clinical information, in addition to the video. Features of the video which helped to make a diagnosis were identified by the reviewers as a part of a survey. RESULTS: A total of 54 patients were included (ES n = 24, PNEE n = 30). Diagnostic accuracy was calculated for each reviewer and combined across all the ratings. Diagnostic accuracy by video alone was 74.5% (sensitivity 80.8%, specificity 66.7%). Providing reviewers with basic clinical information in addition to the videos significantly improved diagnostic accuracy compared to viewing the videos alone. Inter-rater reliability between four reviewers based on the video alone showed moderate agreement (κ = 0.51) and unchanged when additional clinical data were presented (κ = 0.51). The ES group was significantly more likely to demonstrate changes in facial expression, generalized stiffening, repetitive eye blinks, and eye deviation when compared with the PNEE group, which was more likely to display bilateral myoclonic jerking. CONCLUSIONS: Video review of habitual events by Child Neurologists may be helpful in reliably distinguishing ES from PNEE in children, even without included clinical information.

Differences in elective epilepsy monitoring unit admission rates by race/ethnicity and primary payer in New Jersey.

Elective admission to the epilepsy monitoring unit (EMU) is an essential service provided by epilepsy centers, particularly for those with drug-resistant epilepsy. Given previously characterized racial and socioeconomic healthcare disparities in the management of epilepsy, we sought to understand access and utilization of this service in New Jersey (NJ). We examined epilepsy hospitalizations in NJ between 2014 and 2016 using state inpatient and emergency department (ED) databases. We stratified admissions by race/ethnicity and primary payer and used these to estimate and compare (1) admission rates per capita in NJ, as well as (2) admission rates per number of ED visits for each group. Patients without insurance underwent elective EMU admission at the lowest rates across all racial/ethnic groups and payer types studied. Black patients with Medicaid and private insurance were admitted at disproportionately low rates relative to their number of ED visits. Hispanic/Latino and Asian/Pacific Islanders with private insurance, Hispanic/Latinos with Medicaid, and Asian/Pacific Islanders with Medicare were also admitted at low rates per capita within each respective payer category. Future studies should focus on addressing causal factors driving healthcare disparities in epilepsy, particularly for patients without adequate health insurance coverage and those who have been historically underserved by the healthcare system.

Purification of Emu IgY for Therapeutic and Diagnostic Use Based on Monoclonal Secondary Antibodies Specific to Emu IgY.

The emu is the second largest ratite; thus, their sera and egg yolks, obtained after immunization, could provide therapeutic and diagnostically important immunoglobulins with improved production efficiency. Reliable purification tools are required to establish a pipeline for supplying practical emu-derived antibodies, the majority of which belongs to the immunoglobulin Y (IgY) class. Therefore, we generated a monoclonal secondary antibody specific to emu IgY. Initially, we immunized an emu with bovine serum albumin multiply haptenized with 2,4-dinitrophenyl (DNP) groups. Polyclonal emu anti-DNP antibodies were partially purified using conventional precipitation method and used as antigen for immunizing a BALB/c mouse. Splenocytes were fused with myeloma cells and a hybridoma clone secreting a desirable secondary antibody (mAb#2-16) was established. The secondary antibody bound specifically to emu-derived IgY, distinguishing IgYs from chicken, duck, ostrich, quail, and turkey, as well as human IgGs. Affinity columns immobilizing the mAb#2-16 antibodies enabled purification of emu IgY fractions from sera and egg yolks via simple protocols, with which we succeeded in producing IgYs specific to the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) spike protein with a practical binding ability. We expect that the presented purification method, and the secondary antibody produced in this study, will facilitate the utilization of emus as a novel source of therapeutic and diagnostic antibodies.

Phytochemistry, Medicinal Properties, Bioactive Compounds, and Therapeutic Potential of the Genus Eremophila (Scrophulariaceae).

The genus Eremophila (family Scrophulariaceae) consists of approximately 200 species that are widely distributed in the semi-arid and arid regions of Australia. Multiple Eremophila spp. are used as traditional medicines by the First Australians in the areas in which they grow. They are used for their antibacterial, antifungal, antiviral, antioxidant, anti-diabetic, anti-inflammatory, and cardiac properties. Many species of this genus are beneficial against several diseases and ailments. The antibacterial properties of the genus have been relatively well studied, with several important compounds identified and their mechanisms studied. In particular, Eremophila spp. are rich in terpenoids, and the antimicrobial bioactivities of many of these compounds have already been confirmed. The therapeutic properties of Eremophila spp. preparations and purified compounds have received substantially less attention, and much study is required to validate the traditional uses and to highlight species that warrant further investigation as drug leads. The aim of this study is to review and summarise the research into the medicinal properties, therapeutic mechanisms, and phytochemistry of Eremophila spp., with the aim of focussing future studies into the therapeutic potential of this important genus.

Value of smartphone videos for diagnosis of seizures: Everyone owns half an epilepsy monitoring unit.

The diagnosis of epilepsy is primarily based on the history and the verbal description of the events in question. Smartphone videos are increasingly used to assist in the diagnosis. The purpose of this study is to evaluate their value for the diagnosis of seizures. We prospectively collected smartphone videos from patients who presented to our epilepsy center over two years. The video-based diagnosis was then compared to the eventual diagnosis based on video-electroencephalographic (EEG) monitoring with recorded episodes. Video-EEG studies and smartphone videos were reviewed by two separate physicians, each blinded to the other's interpretation. Fifty-four patients were included in the final analysis (mean age = 34.7 years, SD = 17 years). Data (either smartphone video or video-EEG monitoring) were inconclusive in 18 patients. Of the 36 patients with conclusive data, 34 (94%) were in agreement. Smartphone video interpretation can be a useful adjunctive tool in the diagnosis of seizure-like events.

Practice Guidelines for Canadian Neurophysiology Laboratories During the COVID-19 Pandemic.

The COVID-19 pandemic has had a major impact on clinical practice. Safe standards of practice are essential to protect health care workers while still allowing them to provide good care. The Canadian Society of Clinical Neurophysiologists, the Canadian Association of Electroneurophysiology Technologists, the Association of Electromyography Technologists of Canada, the Board of Registration of Electromyography Technologists of Canada, and the Canadian Board of Registration of Electroencephalograph Technologists have combined to review current published literature about safe practices for neurophysiology laboratories. Herein, we present the results of our review and provide our expert opinion regarding the safe practice of neurophysiology during the COVID-19 pandemic in Canada.

Past, Present and Future of Home video-electroencephalographic telemetry: A review of the development of in-home video-electroencephalographic recordings.

Video-electroencephalographic (EEG) monitoring is an essential tool in epileptology, conventionally carried out in a hospital epilepsy monitoring unit. Due to high costs and long waiting times for hospital admission, coupled with technological advances, several centers have developed and implemented video-EEG monitoring in the patient's home (home video-EEG telemetry [HVET]). Here, we review the history and current status of three general approaches to HVET: (1) supervised HVET, which entails setting up video-EEG in the patient's home with daily visiting technologist support; (2) mobile HVET (also termed ambulatory video-EEG), which entails attaching electrodes in a health care facility, supplying the patient and carers with the hardware and instructions, and then asking the patient and carer to set up recording at home without technologist support; and (3) cloud-based HVET, which adds to either of the previous models continuous streaming of video-EEG from the home to the health care provider, with the option to review data in near real time, troubleshoot hardware remotely, and interact remotely with the patient. Our experience shows that HVET can be highly cost-effective and is well received by patients. We note limitations related to long-term electrode attachment and correct camera placing while the patient is unsupervised at home, and concerns related to regulations regarding data privacy for cloud services. We believe that HVET opens significant new opportunities for research, especially in the field of understanding the many influences in seizure occurrence. We speculate that in the future HVET may merge into innovative new multisensor approaches to continuously monitoring people with epilepsy.